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General NPI Number Information
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NPI Number | 1457351991
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Entity Type | Organization
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Legal Business Name | COMMUNITY CANCER FOUNDATION
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 2880 NW STEWART PKWY SUITE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-1201
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Country | US
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Telephone | 541-673-2267
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Fax | 541-672-9483
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Provider Business Mailing Address
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Address Line | 2880 NW STEWART PKWY SUITE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-1201
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Country | US
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Telephone | 541-673-2267
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Fax | 541-672-9483
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TAMMY HAGEDORN
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Credential |
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Telephone | 541-673-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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